Provision of acute general surgery: a systematic review of models of care

Abstract

Background: This article systematically reviews currently available models in Europe, the United Kingdom, Australia and New Zealand for the provision of acute general surgical service and acute care surgery.

Method: Four hundred and thirty eight articles were identified in a literature search. Of these, 13 were included within the systematic review.

Results: Each acute care model is unique to its local and regional setting but all models have common goals. These include being consultant led, adequate resourcing with junior medical staff, theatre space and anaesthetic support and no competing elective surgical or out-patient commitments. All models require an individual, service and institutional commitment to prioritising the assessment and treatment of acute surgical patients and are characterised by uninterrupted periods of work focussed on the care of acute surgical patients supported by comprehensive patient handover to maintain safe staff working hours.

Conclusion: The provision of acute care for surgical patients is a fundamental role of general surgeons. With the diverse demands on surgeons of teaching, research, elective surgery and patient assessments as well as a family and lifestyle obligations newer systems of service provision based on collective, rather than individualised service commitment, are being developed. These systems emphasise discrete periods of defined service without elective surgical commitments with formal and structured surgeon to surgeon handover. Initial experience indicates that patient care is satisfactory, continuity of care is maintained, and acute care pathways function efficiently.

Level of evidence: Systematic review, level IV.